Chapter 20: Family-Centered Home Care Nursing School Test Banks

Chapter 20: Family-Centered Home Care

MULTIPLE CHOICE

1. Home care is being considered for a young child who is ventilator-dependent. Which factor is most important in deciding whether home care is appropriate?
a. Level of parents education
b. Presence of two parents in the home
c. Preparation and training of family
d. Familys ability to assume all health care costs
ANS: C
One of the essential elements is the familys training and preparation. The family must be able to demonstrate all aspects of care for the child. In many areas, it cannot be guaranteed that nursing care will be available on a continual basis, and the family will have to care for the child. The amount of formal education reached by the parents is not the important issue. The determinant is the familys ability to care adequately for the child in the home. At least two family members should learn and demonstrate all aspects of the childs care in the hospital, but it does not have to be two parents. Few families can assume all health care costs. Creative financial planning, including negotiating arrangements with the insurance company and/or public programs, may be required.

2. The home health nurse asks a childs mother many questions as part of the assessment. The mother answers many questions, then stops and says, I dont know why you ask me all this. Who gets to know this information? The nurse should take which action?
a. Determine why the mother is so suspicious.
b. Determine what the mother does not want to tell.
c. Explain who will have access to the information.
d. Explain that everything is confidential and that no one else will know what is said.
ANS: C
Communication with the family should not be invasive. The nurse needs to explain the importance of collecting the information, its applicability to the childs care, and who will have access to the information. The mother is not being suspicious and is not necessarily withholding important information. She has a right to understand how the information she provides will be used. The nurse will need to share, through both oral and written communication, clinically relevant information with other involved health professionals.

3. When communicating with other professionals, it is important for home care nurses to:
a. ask others what they want to know.
b. share everything known about the family.
c. restrict communication to clinically relevant information.
d. recognize that confidentiality is not possible.
ANS: C
The nurse will need to share, through both oral and written communication, clinically relevant information with other involved health professionals. Asking others what they want to know and sharing everything known about the family is inappropriate. Patients have a right to confidentiality. The nurse is not permitted to share information about clients, except clinically relevant information that pertains to the childs care. Confidentiality permits the disclosure of information to other health professionals on a need-to-know basis.

4. The home health nurse is caring for a child who requires complex care. The family expresses frustration related to obtaining accurate information about their childs illness and its management. Which is the best action for the nurse?
a. Determine why family is easily frustrated.
b. Refer family to childs primary care practitioner.
c. Clarify familys request, and provide information they want.
d. Answer only questions that family needs to know about.
ANS: C
The philosophic basis for family-centered practice is the recognition that the family is the constant in the childs life. It is essential and appropriate that the family have complete and accurate information about their childs illness and management. The nurse may first have to clarify what information the family believes has not been communicated. The familys frustration arises from their perception that they are not receiving information pertinent to their childs care. Referring the family to the childs primary care practitioner does not help the family. The home health nurse should have access to the necessary information. Questions about what they need and want to know concerning their childs care should be addressed.

5. A family wants to begin oral feeding of their 4-year-old son, who is ventilator-dependent and currently tube-fed. They ask the home health nurse to feed him the baby food orally. The nurse recognizes a high risk of aspiration and an already compromised respiratory status. The most appropriate nursing action is to:
a. refuse to feed him orally because the risk is too high.
b. explain the risks involved, and then let the family decide what should be done.
c. feed him orally because the family has the right to make this decision for their child.
d. acknowledge their request, explain the risks, and explore with the family the available options.
ANS: D
Parents want to be included in the decision making for their childs care. The nurse should discuss the request with the family to ensure this is the issue of concern, and then they can explore potential options together. Merely refusing to feed the child orally does not determine why the parents wish the oral feedings to begin and does not involve them in the problem solving. The decision to begin or not change feedings should be a collaborative one, made in consultation with the family, nurse, and appropriate member of the health care team.

6. The home health nurse outlines short- and long-term goals for a 10-year-old child with many complex health problems. Who should agree on these goals?
a. Family and nurse
b. Child, family, and nurse
c. All professionals involved
d. Child, family, and all professionals involved
ANS: D
In the home, the family is a partner in each step of the nursing process. Family priorities should guide the planning process. Both short- and long-term goals should be outlined and agreed on by the child, family, and professionals involved. Involvement of the individuals who are essential to the childs care is necessary during this important stage. The elimination of any one of these groups can potentially create a care plan that does not meet the needs of the child and family.

7. One of the supervisors for a home health agency asks the nurse to give the family a survey evaluating the nurses and other service providers. The nurse should recognize this as:
a. inappropriate, unless nurses are able to evaluate family.
b. appropriate to improve quality of care.
c. inappropriate, unless nurses and other providers agree to participate.
d. inappropriate, because family lacks knowledge necessary to evaluate professionals.
ANS: B
Quality assessment and improvement activities are essential for virtually all organizations. Family involvement is essential in evaluating a home care plan and can occur on several levels. The nurse can ask the family open-ended questions at regular intervals to assess their opinion of the effectiveness of care. Families should also be given an opportunity to evaluate the individual home care nurses, the home care agency, and other service providers periodically. The nurse is the care provider. The evaluation is of the provision of care to the patient and family. The nurses role is not to evaluate the family. Quality-monitoring activities are required by virtually all health care agencies. During the evaluation process, the family is requested to provide their perceptions of care.

8. The home care nurse has been visiting an adolescent with recently acquired quadriplegia. The teens mother tells the nurse, Im sick of providing all the care while my husband does whatever he wants to, whenever he wants to do it. Which should be the initial action of the nurse?
a. Refer mother for counseling.
b. Listen and reflect mothers feelings.
c. Ask father, in private, why he does not help.
d. Suggest ways the mother can get her husband to help.
ANS: B
It is appropriate for the nurse to reflect with the mother about her feelings, exploring issues such as an additional home health aide to help care for the child and provide respite for the mother. It is inappropriate for the nurse to agree with the mother that her husband is not helping enough. It is a judgment beyond the role of the nurse and can undermine the family relationship. Counseling is not necessary at this time. A support group for caregivers may be indicated. Asking the father why he does not help and suggesting ways to the mother to get her husband to help are interventions based on the mothers assumption of minimal contribution to the childs care. The father may have a full-time job and other commitments. The parents need to have an involved third person help them through the negotiation of responsibilities for the loss of their normal child and new parenting responsibilities.

9. The home health nurse is planning care for a 3-year-old boy who has Down syndrome and is receiving continuous oxygen. He recently began walking around furniture. He is spoon-fed by his parents and eats some finger foods. Which is the most appropriate goal to promote normal development?
a. Encourage mobility.
b. Encourage assistance in self-care.
c. Promote oral-motor development.
d. Provide opportunities for socialization.
ANS: A
A major principle for developmental support in children with complex medical issues is that it should be flexible and tailored to the individual childs abilities, interests, and needs. This child is exhibiting readiness for ambulation. It is an appropriate time to provide activities that encourage mobility, for example, longer oxygen tubing. Parents should provide decreasing amounts of assistance with self-care as he is able to develop these skills. He is receiving oral foods and is eating finger foods. He has acquired oral-motor development. Mobility is a new developmental task. Opportunities for socialization should be ongoing.

10. A mother of a 5-year-old child, with complex health care needs and cared for at home, expresses anxiety about attending a kindergarten graduation exercise of a neighbors child. The mother says, I wish it could be my child graduating from kindergarten. The nurse recognizes that the mother is experiencing:
a. abnormal anxiety.
b. ineffective coping.
c. chronic sorrow.
d. denial.
ANS: C
Home care nurses should be aware that parents may experience chronic sorrow as a parental stressor. Chronic sorrow as a normal grief response is associated with a living loss (the loss of a healthy child) that is cyclical in nature. This is a normal response and does not indicate abnormal anxiety, ineffective coping, or denial.

11. A ventilator-dependent child is cared for at home by his parents. Nurses come for 4 hours each day giving the parents some relief. Which other strategy should the nurse recommend to give the parents a break from the responsibilities of caring for a ventilator-dependent child?
a. Encourage members from the parents church group to provide some relief care.
b. Train a trusted grandparent to provide an occasional break from the responsibilities of care.
c. Encourage the parents to pay out of pocket for additional private duty nurses.
d. Suggest the parents place the child in a care facility.
ANS: B
Respite care provides temporary relief to parents and allows a break from the responsibilities of caring for the ventilator-dependent child on a daily basis. For example, a trusted and trained grandparent or extended family member may be called in to give the family a break from caring for the child. Members of the parents church group would not have the training necessary to care for a ventilator-dependent child. Asking the parents to pay out of pocket for additional care would put a financial burden on the family. Suggesting the family place the child in a care facility is inappropriate.

12. A nurse manager at a home-care agency is planning a continuing education program for the home-care staff nurses. Which type of continuing education program should the nurse manager plan?
a. On-line training modules
b. A structured written teaching module each nurse completes individually
c. A workshop training day, with a professional speaker, where nurses can interact with each other
d. One-on-one continuing education training with each nurse
ANS: C
Because of the unique practice environment of home care nurses, it is important for an agency to facilitate sharing among peers to decrease work-related stress, increase job satisfaction, and support high-quality patient care. On-line training, written teaching modules, and one-on-one training would not allow for any sharing with peers.

13. A priority intervention the home-care nurse should teach parents to do to maintain infection control is:
a. sterilize equipment.
b. reuse equipment to decrease costs.
c. use proper hand hygiene.
d. use gloves when repositioning the child.
ANS: B
Hand hygiene is the cornerstone of infection control, and the nurse should teach parents the practice and help identify appropriate areas in the home setting for hand hygiene to be carried out with ease. Equipment can be cleaned in the home setting, but there is no means to sterilize equipment and because the child is exposed to fewer organisms in the home setting use of sterile equipment on a daily basis is not warranted. Some medical equipment may be washed with an appropriate disinfectant and reused to decrease cost of care; however, appropriate infection control practices should not be compromised to save money. It is not necessary to wear gloves when repositioning the child. Gloves would be worn only when protective personal equipment (PPE) is required.

1. Which behaviors by the nurse indicate therapeutic nurse-family boundaries? (Select all that apply.)
a. Nurse visits family on days off.
b. House rules are negotiated.
c. Nurse buys child expensive gifts.
d. Communication is open and two-way.
ANS: B, D
A home care nurse can establish therapeutic nurse-family boundaries by negotiating house rules and ensuring that communication is open and two-way. Visiting the family of off-duty days and buying expensive gifts for the child would be boundary crossing and nontherapeutic.

2. A child dependent on medical technology is preparing to be discharged from the hospital to home. Which predischarge assessments should the nurse ensure? (Select all that apply.)
a. Emergency care and transport plan
b. Reliance on private duty nurses to teach the family infection control practices
c. Financial arrangements
d. Individualized home plan to be completed within the first month of the childs discharge
ANS: A, C
The predischarge plan for a child dependent on medical technology going home should include emergency care and transport plan and financial arrangements. The infection control practices and individualized home plan should be completed before discharge, not after the child goes home.